Wednesday, March 14, 2012

CMS Issues Proposed Coverage Decision for TENS

Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed decision memo on electrical nerve stimulation for chronic low back pain. APTA is analyzing the proposal and will post a summary of the memo on its Web site next week.

In October 2011, APTA submitted comments to CMS outlining the association's concerns with a national policy limiting local Medicare contractors' ability to assess the medical necessity of TENS. APTA included evidence in its comments to support TENS efficacy for chronic low back pain when used appropriately.

Comments

Please help support TENS Coverage for low back pain. Visit TENScoverage.com to sign the petition and show your support.

Posted by Jerry Correia
on 3/15/2012 10:15 PM

I can not believe that CMS used this 3 page systematic review, which was largely based on only 5 articles, to propose this policy change! The review was largely based on individuals with Chronic LBP with impaired neurological systems. In the only two studies which showed TENS had no effect the participants also had MS! Is this really any surprise? Another fault with this review is that CMS then used this data to generalize that TENS has no effect on all people, including those without MS or other neurological conditions. Sure seems like faulty logic to me. Anybody else see it this way? Any other insights?

Posted by Joseph M. Eschman PT,GCS
on 3/16/2012 12:16 AM

I haven't read the details but I have not used a TENS unit in about 25 years, and I will not dispense them. I believe most chronic low back pain patients have been disabled and made chronic by misinformed providers who offer bad advice and passive modalities to treat a condition that has no proven anatomical or physiological basis (a "disease" or "pathology"). In my experience psychosocial issues are the mitigating factor in achieving some sense of normalcy. Fear avoidance beliefs and just basic beliefs systems are the root of the problem in many if not most cases. Depression plays a big role also, but I feel this is iatrogenic often.

Posted by Ed Scott PT, DPT, OCS
on 3/17/2012 5:57 AM

TENS can be extremely effective for any condition if used properly. Just placing electrodes on painful sites is the least effective. By using movable sponge spotting electrodes and finding appropriate sites, especially acupuncture points, the efficiency and relief is over 80%. The spasms and pain are both relieved. The government should stay out of the treatment mode and the therapists should learn to use this effective device.

Posted by Ken Lamm PT
on 3/17/2012 10:03 AM

My first lumbar fracture occured in 1977, and the next in 1995. My right hip has also been fractured 3 times and all the ribs on my right side fractured. I speak from personal as well as clinical experience after 15 years on the right side of therapy.
There are times when I have seen relief from lumbar pain through use of E-stim, in myself and my patients. It's effect is increased with daily adherence to a very specific exercise program. No amount of E-stim works as a stand alone unit. And despite our best efforts, I still sometimes require meds to be able to stand up without grunting.
Is E-stim effective? Yes.
Should it be paid for by insurance? Yes.
Will it save money in the long run? Yes, if coupled with other proven therapies.

Posted by patrick tierney PTA
on 3/17/2012 10:02 PM

There is always bias when examining treatment modalities such as this. CMS has an obvious bias of wanting to reduce expenses. All responses including mine have a biased point of view. The real question to be asked is whether or not there are patients who benefit from TENS as either a primary or adjunct form of treatment for chronic low back pain. Some believe that there is no physiologic basis for its use. That, I fear, is a very near sighted point of view and does not take into account the very real bio-molecular neurophysiology of pain itself. Yes, thought processes including depression have both an affective and an effective impact on neurophysiology. To view the patient as simply a musculoskeletal and simple neurophysiological entity is to discount the wonder of who we essentially are. To do so, in the interest of saving money, is borderline criminal. Yes I have used TENS with chronic pain patients with very positive benefits and I have also used it with no impact whatsoever. This is yet another attempt to apply so called "evidence based treatment" principles in a way that discounts the foundation of Evidence Based practice...the clinician.

Posted by Paul Hockett PT
on 3/19/2012 10:12 AM

I think that transcutaneous electrical nerve stimulation when used properly and educated to clients and patients can be a viable treatment intervention and option. I think that it can also be helpful with pre-treatment for individuals who may have pharmacological compromise or for those who prefer not to utilize surgical interventions. Clinically, I have seen positive results for returning individuals to functional daily skills and managing symptoms independently.
Just a professional opinion.

Posted by Heidi Harris
on 3/19/2012 11:48 AM

We have to make our voices heard regarding the use of GOOD evidence being used to make policy--we can't stand for shoddy evidence being used by CMS, Anthem, or other payors. We will always be biased in our opinions and experiences AND we can be better and better, as improved evidence becomes available, at making informed evidence-based clinical decisions and informing policy makers at every level...WE are the creators of the answer to this issue but we have to have some science to back us up and WE have to help contribute to that as well!!!

Posted by Beth (Rini) Scott, PT, DPT, GCFP
on 3/25/2012 2:26 PM

Please continue the medicare coverage for the tens unit.I would not be able to function each day and do my chores with out my tens unit. I am 73 years old and have severe low back pain, without the tens unit I would be on pain pills all the time.

Posted by Mary Ann Johnson
on 5/20/2012 9:50 AM

I don't use my tens unit every day,but when I need it, it is the only thing that helps.

Posted by W. A.Taylor
on 5/21/2012 11:05 AM

I use it for lower bqack anf mostly for neck area. I think it helps a lot of people so why discontinue coverage, some peopple really need it.

Posted by Maureen Fish
on 5/26/2012 5:59 PM

without it I would be in worse pain than I am now. After I am using TENS it relieves the pain in my back . I have 3 dices out and the pain is worse than I have ever had. Even child birth. So without it I would be an invalid in a Nursing home . . The need is great.

Posted by Sheila Bailey
on 6/6/2012 12:37 PM

Dear Sir's, I have been using the TENS since my first car accident, 1993. I have been in four accidents, as a passenger, & we were never at fault. I use the TENS for all over body pain,as I have to go to England to have my forth neck surgery(not availble in the US)When a person turns 60, to be denied treatment of any type is so un American!!!!!! Congress needs to live with the type of insurance that we do, after working all the years we have.So I am begging all of you to STOP, THINK, & LISTEN to we the TAXPAYER'S, not the illeagels who receive any & every thing.Also our insuance is not Medicare, it is Anthem Bue Cross,which we receive after my husbandworked over 33 years to have this benifits.

Posted by Carole I Blalock
on 6/11/2012 5:31 PM

I use my tens every day, most of the day. It's not only for chronic low back pain, it's also for my severe nerve pain in legs,iliac joints, upper back with muskulo skeletal, radial nerve damage, neuropathy.If I didn't have that,it would be alot harder to walk.It has helped me decrease my pain meds drastically, refused another surgery from 1986 & 1987, with no results & was rented for me to try tens. It would save the states millions of dollars. There needs to be more people writing in on this with their results on the internet. It also helps with the tens belts, as alot of us are unable to reach certain places to get the electrodes on.

Posted by Cher Heidecker
on 6/23/2012 1:08 PM

My tens I use every day I have chronic lower back pain also upper and middle back pain also in my neck.Without my tens I wouldn't be able to get around.My tens helps me so much.Its a blessing or I would have to be on pain pills all the time....

Posted by Barbara Geyer
on 6/25/2012 9:00 PM

I use my tens machine every day for my lower back pain and for my neck pain (for degenerative discs) It helps to relieve my pain. Without it I
will always have to be on pain meds.

Posted by Anna R Celeste
on 8/5/2012 12:00 AM

I use my tens machine everyday for lower and mid back pain.It helps me more than you will ever know.

Posted by Wanda Black
on 9/5/2012 6:58 PM

I have arthritis in the spine and use a tens unit to reduce or change the emphasis of the pain in my back, and legs.

Posted by Nancy Steward
on 1/13/2013 5:45 PM

I have a Empi Slect unit and knee unit also the belt one
I have a disc bulg and nerve damage and osteoarthritis
My neck is bad too my whole spine is out of alignment
I hurt in my back, arms, knees, back of legs, goin area
My Empi allows me to walk and sleep keep off of
Very bad drugs.
I just found out Medicare will not allow for back pain, also just two patches a month. It takes four for knee device alone, I use the butterfly one to put different areas from neck to back then two on hip. The patches do not last a whole month if you use 24 hrs a day. Medicare you are being just out right mean to let a person suffer like a wonded animal Shame on you